A Novel 3D Printed Custom Antibiotic Spacer Mold for Osteomyelitis Cases which are Prone to Instability
Abstract
Presence of complex bone defects in osteomyelitis treatment may be challenging for the surgeon. Antibiotic cement spacers take a role in managing these defects. The available techniques and systems of antibiotic cement spacers have their pros and cons. There are cases in which these standard options may fail, mainly due to stability related issues. In this report, we present an antibiotic spacer technique in a very complex bone defect that is prone to failure if managed by routine spacer applications. Anticipating that any standard spacer application methodology will fail, we decided to make our own custom antibiotic cement spacer. We used the patient's uninjured side's tomography data to create a custom 3D spacer mold model with the help of a computer software. Later this 3D spacer mold model was printed with a 3D printer. The print out was sterilized and used to cast a custom antibiotic cement spacer resulting in a perfect fit in the defect.References
Rasyid HN, van der Mei HC, Frijlink HW, et al. Concepts for increasing gentamicin release from handmade bone cement beads. Acta Orthop. 2009;80:508-13.
Giavaresi G, Bertazzoni Minelli E, Sartori M, et al. New PMMA-based composites for preparing spacer devices in prosthetic infections. J Mater Sci Mater Med. 2012;23:1247-57.
Mounasamy V, Fulco P, Desai P, Adelaar R, Bearman G. The successful use of vancomycin-impregnated cement beads in a patient with vancomycin systemic toxicity: a case report with review of literature. Eur J Orthop Surg Traumatol. 2012;23:299-302.
Sener M, Kazimoglu C, Karapinar H, Günal I, Afşar I, Karataş Sener AG. Comparison of various surgical methods in the treatment of implant-related infection. Int Orthop. 2010;34:419-23.
Van Thiel GS, Berend KR, Klein GR, Gordon AC, Lombardi AV, Della Valle CJ. Intraoperative molds to create an articulating spacer for the infected knee arthroplasty. Clin Orthop Relat Res. 2011;469:994-1001.
Jung J, Schmid NV, Kelm J, Schmitt E, Anagnostakos K. Complications after spacer implantation in the treatment of hip joint infections. Int J Med Sci. 2009;6:265-73.
Pattyn C, De Geest T, Ackerman P, Audenaert E. Preformed gentamicin spacers in two-stage revision hip arthroplasty: functional results and complications. Int Orthop. 2011;35:1471-6.
Paley D, Herzenberg JE. Intramedullary infections treated with antibiotic cement rods: preliminary results in nine cases. J Orthop Trauma. 2002;16:723-9.
Jawa A, Shi L, O’Brien T, et al. Prosthesis of antibiotic-loaded acrylic cement (PROSTALAC) use for the treatment of infection after shoulder arthroplasty. J Bone Joint Surg Am. 2011;93:2001-9.
Coffey MJ, Ely EE, Crosby LA. Treatment of glenohumeral sepsis with a commercially produced antibiotic-impregnated cement spacer. J Shoulder Elbow Surg. 2010;19:868-73.
Stine IA, Lee B, Zalavras CG, Hatch G 3rd, Itamura JM. Management of chronic shoulder infections utilizing a fixed articulating antibiotic-loaded spacer. J Shoulder Elbow Surg. 2010;19:739-48.
